efile Public Visual Render
ObjectId: 202223159349303562 - Submission: 2022-11-11
TIN: 23-7383042
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
Attach to Form 990.
Go to
www.irs.gov/Form990
for instructions and the latest information.
OMB No. 1545-0047
20
21
Open to Public Inspection
Name of the organization
HENRY FORD HEALTH SYSTEM FOUNDATION
Employer identification number
23-7383042
Part I
Identification of Disregarded Entities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Total income
(e)
End-of-year assets
(f)
Direct controlling
entity
Part II
Identification of Related Tax-Exempt Organizations.
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))
(f)
Direct controlling
entity
(g)
Section 512(b)(13) controlled entity?
Yes
No
(1)
HENRY FORD HEALTH SYSTEM
ONE FORD PLACE
DETROIT
,
MI
48202
38-1357020
HEALTHCARE SERVICE PROVIDER
MI
501(C)(3)
LINE 3
N/A
No
(2)
HENRY FORD WYANDOTTE HOSPITAL
2333 BIDDLE AVE
WYANDOTTE
,
MI
48192
38-2791823
HEALTHCARE SERVICE PROVIDER
MI
501(C)(3)
LINE 3
HENRY FORD HEALTH SYSTEM
Yes
(3)
HEALTH ALLIANCE PLAN
2850 W GRAND BLVD
DETROIT
,
MI
48202
38-2242827
HEALTH MAINTENANCE ORGANIZATION
MI
501(C)(4)
N/A
HENRY FORD HEALTH SYSTEM
Yes
(4)
HFII CORPORATION
ONE FORD PLACE
DETROIT
,
MI
48202
90-0840304
SCIENTIFIC RESEARCH
MI
501(C)(3)
LINE 7
HENRY FORD HEALTH SYSTEM
Yes
(5)
HENRY FORD HEALTH SYSTEM GOVERNMENT AFFAIRS SERVICES
ONE FORD PLACE
DETROIT
,
MI
48202
46-4064067
ADVOCACY SERVICES FOR HF HEALTH AND AFFILIATES
MI
501(C)(4)
N/A
HENRY FORD HEALTH SYSTEM
Yes
(6)
HENRY FORD MACOMB HOSPITAL CORPORATION
ONE FORD PLACE
DETROIT
,
MI
48192
38-2947657
HEALTHCARE SERVICE PROVIDER
MI
501(C)(3)
LINE 3
HENRY FORD HEALTH SYSTEM
Yes
(7)
HENRY FORD ALLEGIANCE HEALTH GROUP
205 N EAST AVENUE
JACKSON
,
MI
49201
38-2756428
EXEMPT ORGANIZATION
MI
501(C)(3)
LINE 12B, II
HENRY FORD HEALTH SYSTEM
Yes
(8)
ALLEGIANCE HEALTH FOUNDATION
205 N EAST AVENUE
JACKSON
,
MI
49201
38-3607833
SUPPORTING ORGANIZATION
MI
501(C)(3)
LINE 12B, II
HENRY FORD ALLEGIANCE HEALTH GROUP
Yes
(9)
HOSPICE OF JACKSON DBA ALLEGIANCE HOSPICE
205 N EAST AVENUE
JACKSON
,
MI
49201
38-2336367
HOSPICE
MI
501(C)(3)
LINE 7
HEALTHLINK
Yes
(10)
HEALTHLINK
205 N EAST AVENUE
JACKSON
,
MI
49201
38-2756425
HOME HEALTH CARE
MI
501(C)(3)
LINE 12A, I
HENRY FORD ALLEGIANCE HEALTH GROUP
Yes
(11)
CARELINK OF JACKSON
110 NORTH ELM AVENUE
JACKSON
,
MI
49202
38-1218485
LONG TERM ACUTE HOSPITAL
MI
501(C)(3)
LINE 3
HENRY FORD ALLEGIANCE HEALTH GROUP
Yes
(12)
WA FOOTE MEMORIAL HOSPITAL DBA HENRY FORD HEALTH JACKSON HOSPITAL
205 N EAST AVENUE
JACKSON
,
MI
48201
38-2027689
HEALTHCARE SERVICE PROVIDER
MI
501(C)(3)
LINE 3
HENRY FORD ALLEGIANCE HEALTH GROUP
Yes
(13)
THE CLARENCE S LIVINGOOD LECTURESHIP AND EDUCATION FUND
3031 WEST GRAND BOULEVARD NO 800
DETROIT
,
MI
48202
38-2682321
SUPPORTING ORGANIZATION
MI
501(C)(3)
LINE 12B, II
HENRY FORD HEALTH SYSTEM
Yes
(14)
HENRY FORD PHYSICIAN PARTNERS
ONE FORD PLACE
DETROIT
,
MI
48202
87-1633901
PHYSICIAN SERVICES
MI
501(C)(3)
LINE 3
HENRY FORD HEALTH SYSTEM
Yes
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2021
Page 2
Schedule R (Form 990) 2021
Page
2
Part III
Identification of Related Organizations Taxable as a Partnership.
Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
(1)
NORTHWEST DETROIT DIALYSIS
30100 TELEGRAPH
BINGHAM FARMS
,
MI
48025
38-3232668
OPERATE DIALYSIS CLINIC
MI
HENRY FORD HEALTH SYSTEM
N/A
No
No
(2)
MACOMB REGIONAL DIALYSIS CENTERS
16151 NINETEEN MILE RD
CLINTON TOWNSHIP
,
MI
48038
26-0423581
OPERATE DIALYSIS CLINIC
MI
HENRY FORD HEALTH SYSTEM
N/A
No
No
(3)
FOOTE HEALTH CENTER ASSOCIATES
1100 E MICHIGAN AVENUE
JACKSON
,
MI
49201
38-3017711
LESSOR OF MEDICAL CONDOMINIUM
MI
HENRY FORD ALLEGIANCE HEALTH GROUP
RELATED
No
No
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust.
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes
No
(1)
SHA REALTY INC
ONE FORD PLACE
DETROIT
,
MI
48202
38-1378121
REAL ESTATE HOLDING
MI
HENRY FORD HEALTH SYSTEM FOUNDATION
C
637,777
8,428,870
100.000 %
Yes
(2)
FAIRLANE HEALTH SERVICES
30100 TELEGRAPH
BINGHAM FARMS
,
MI
48025
38-2565235
HEALTHCARE MANAGEMENT
MI
HENRY FORD HEALTH SYSTEM
C
Yes
(3)
ALLIANCE HEALTH AND LIFE INSURANCE
2850 W GRAND BLVD
DETROIT
,
MI
48202
38-3291563
HEALTH INSURANCE PROVIDER
MI
HEALTH ALLIANCE PLAN
C
Yes
(4)
HAP PREFERRED INC
2850 W GRAND BLVD
DETROIT
,
MI
48202
38-2513504
PROVIDER NETWORK LEASING
MI
HEALTH ALLIANCE PLAN
C
Yes
(5)
ONIKA INSURANCE LTD
FIRST CARRIBEAN HOUSE
GRAND CAYMAN CAYMAN ISLANDS
CJ
CAPTIVE INSURANCE
CJ
HENRY FORD HEALTH SYSTEM
C
Yes
(6)
HENRY FORD PHYSICIAN NETWORK
ONE FORD PLACE
DETROIT
,
MI
48202
32-0306774
PHYSICIAN NETWORK
MI
HENRY FORD HEALTH SYSTEM
C
Yes
(7)
ADMINISTRATION SYSTEMS RESEARCH CORPORATION
2850 W GRAND BLVD
DETROIT
,
MI
48202
38-2651185
THIRD PARTY INSURANCE ADMINISTRATOR
MI
HEALTH ALLIANCE PLAN
C
Yes
(8)
HAP EMPOWERED HEALTH PLAN INC
2850 W GRAND BLVD
DETROIT
,
MI
48202
38-3123777
HEALTH INSURANCE PROVIDER
MI
HEALTH ALLIANCE PLAN
C
Yes
(9)
HENRY FORD ALLEGIANCE PHARMACY
205 N EAST AVENUE
JACKSON
,
MI
49201
38-3370242
PHARMACY
MI
HENRY FORD ALLEGIANCE HEALTH GROUP
C
Yes
(10)
HENRY FORD ELIJAH MCCOY CONDOMINIUM ASSOCIATION
1150 ELIJAH MCCOY DR
DETROIT
,
MI
48202
85-2144748
CONDOMINIUM ASSOCIATION
MI
HENRY FORD HEALTH SYSTEM
S
Yes
Schedule R (Form 990) 2021
Page 3
Schedule R (Form 990) 2021
Page
3
Part V
Transactions With Related Organizations.
Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note.
Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1
During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a
Receipt of
(i)
interest,
(ii)
annuities,
(iii)
royalties, or
(iv)
rent from a controlled entity
.....................
1a
No
b
Gift, grant, or capital contribution to related organization(s)
............................
1b
Yes
c
Gift, grant, or capital contribution from related organization(s)
............................
1c
No
d
Loans or loan guarantees to or for related organization(s)
............................
1d
No
e
Loans or loan guarantees by related organization(s)
............................
1e
No
f
Dividends from related organization(s)
............................
1f
No
g
Sale of assets to related organization(s)
............................
1g
No
h
Purchase of assets from related organization(s)
............................
1h
No
i
Exchange of assets with related organization(s)
............................
1i
No
j
Lease of facilities, equipment, or other assets to related organization(s)
.......................
1j
No
k
Lease of facilities, equipment, or other assets from related organization(s)
......................
1k
No
l
Performance of services or membership or fundraising solicitations for related organization(s)
.....................
1l
No
m
Performance of services or membership or fundraising solicitations by related organization(s)
.................
1m
No
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
...................
1n
No
o
Sharing of paid employees with related organization(s)
............................
1o
No
p
Reimbursement paid to related organization(s) for expenses
............................
1p
No
q
Reimbursement paid by related organization(s) for expenses
............................
1q
No
r
Other transfer of cash or property to related organization(s)
............................
1r
No
s
Other transfer of cash or property from related organization(s)
............................
1s
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1)
HENRY FORD HEALTH SYSTEM
B
17,125,084
CASH VALUE
Schedule R (Form 990) 2021
Page 4
Schedule R (Form 990) 2021
Page
4
Part VI
Unrelated Organizations Taxable as a Partnership.
Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)
(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income
(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
Yes
No
Schedule R (Form 990) 2021
Page 5
Schedule R (Form 990) 2021
Page
5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. See instructions.
Return Reference
Explanation
SCHEDULE R, PART V, LINE 1D & 1E:
THE ORGANIZATION, AS A DESIGNATED AFFILIATE, IS A MEMBER OF THE HENRY FORD HEALTH SYSTEM CREDIT GROUP. MEMBERS OF THE CREDIT GROUP ARE JOINTLY AND SEVERALLY LIABLE FOR OUTSTANDING OBLIGATIONS ISSUED UNDER THE 2016 AND 2019 HFHS BOND MASTER INDENTURES.
Schedule R (Form 990) 2021
Additional Data
Software ID:
Software Version: